MEDICARE: CITY OF MATTOON ILLINOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	06 6689	IL

General Provider Information

NPI Number	:	1922275106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MATTOON ILLINOIS

Provider Business Mailing Address
First Line	:	1812 PRAIRIE AVE
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-2951
Country	:	US
Telephone Number	:	217-234-2442
Fax Number	:	217-234-2448

Provider Business Practice Location Address
First Line	:	1812 PRAIRIE AVE
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-2951
Country	:	US
Telephone Number	:	217-234-2442
Fax Number	:	217-234-2448

Authorized Official
Title or Position	:	MAYOR
Name	:	MR. DAVID W CLINE
Credential	:
Telephone Number	:	217-234-4633

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	09/24/2008

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Directions to “CITY OF MATTOON ILLINOIS ” Practice Location

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